Main Article Content
Emergency Medical Services, Prescription Drugs, Pharmacies, Community Pharmacy Services, Prescription Fees, Pharmacists, Retrospective Studies, United States
Objectives: The purpose of this study was to describe the rate of medication short-term supply dispensings (tider), patient and medication characteristics associated with a tider, and costs for tider dispensings in an integrated healthcare delivery system in Colorado, United States.
Methods: This was a retrospective study conducted in an integrated healthcare delivery system’s outpatient clinics. All patients who had a prescription dispensed for a study medication at any of the system’s 28 outpatient pharmacies during the first quarter of 2016 were included. A tider was identified as a 3-day supply of a prescription medication that was dispensed at no charge to a patient. The quarterly tider rate and the per member per month (PMPM) cost of tiders were estimated. Patient and medication characteristics associated with a tider were assessed.
Results: A total of 444,225 study medications were dispensed for 135,907 patients during the study period. There were 3,430 (0.77%, 95%CI 0.75%:0.80%) medications dispensed as a tider. The PMPM cost of tider medications and their dispensing fees was USD 0.03. There were 1,092 (0.8%) and 134,815 (99.2%) patients who did and did not, respectively, have at least one tider dispensed during the study period. Patient characteristics strongly associated with having had a tider dispensed included being older, male, and a Medicare beneficiary. Cardiovascular and neuromuscular medications had the highest rates of tider dispensing.
Conclusions: The rate of tider dispensing was relatively low; however, approximately one out of 125 patients had at least one tider. Patients who had a tider were more likely to be older, female, a Medicare beneficiary, and having had a previous tider dispensing and a higher burden of chronic disease. The tider medication was more likely to be a cardiovascular or neuromuscular medication class and more likely to be dispensed on a weekend. The total cost of dispensing a tider appears reasonable since the benefits of providing patients with needed medications likely outweigh the cost. Future studies should be performed to assess the impact of tider dispensing on health outcomes.
2. Social Security. Payment for covered outpatient drugs. Available at: https://www.ssa.gov/OP_Home/ssact/title19/1927.htm (accessed cited 25-Jan-2017).
3. Lester CA, Chui MA. The prescription pickup lag, an automatic prescription refill program, and community pharmacy operations. J Am Pharm Assoc (2003). 2016;56(4):427-432. doi: 10.1016/j.japh.2016.03.010
4. Morecroft CW, Mackridge AJ, Stokes EC, Gray NJ, Wilson SE, Ashcroft DM, Mensah N, Pickup GB. Emergency supply of prescription-only medicines to patients by community pharmacists: a mixed methods evaluation incorporating patient, pharmacist and GP perspectives. BMJ Open. 2015;5(7):e006934. doi: 10.1136/bmjopen-2014-006934
5. O’Neil R, Rowley E, Smith F. The emergency supply of prescription-only medicines: a survey of requests to community pharmacists and their views on the procedures. Int J Pharm Pract. 2002;10:77-83. doi: 10.1111/j.2042-7174.2002.tb00591.x
6. Seal DW, Walton J, Williams S, Wilson R, Smith-Benson J 2nd. Survey regarding provisions of a 3-day supply of an antihypertensive. J Pharm Pract. 2014;27(4):364-368. doi: 10.1177/0897190013508140
7. Shepherd MD. Examination of why some community pharmacists do not provide 72-hour emergency prescription drugs to Medicaid patients when prior authorization is not available. J Manag Care Pharm. 2013;19(7):523-533. doi: 10.18553/jmcp.2013.19.7.523
8. Clark DO, Von Korff M, Saunders K, Baluch WM, Simon GE. A chronic disease score with empirically derived weights. Med Care. 1995;33(8):783-795.
9. Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, Saunders LD, Beck CA, Feasby TE, Ghali WA. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43(11):1130-1139.
10. Grant Thornton. Cost of dispensing study. An independent comparative analysis of U.S. prescription dispensing costs [Internet]. Coalition for Community Pharmacy Action. Available at: http://www.ncpanet.org/pdf/codstudy-execsumm.pdf (accessed cited 25-Jan-2017).
11. Liow K, Barkley GL, Pollard JR, Harden CL, Bazil CW. Position statement on the coverage of anticonvulsant drugs for the treatment of epilepsy. Neurology. 2007;68(16):1249-1250. doi: 10.1212/01.wnl.0000259400.30539.cc